Perimenopause?

I have recently been told I am in perimenopause.  I am 39 have a history of severe endometriosis, autoimmune disease, secondary adrenal insufficiency and nonfunctional pituitary microadenoma.  I've had two surgeries for the endometriosis and have had one ovary removed.   I have had to take birth control pills for most of my life due to the endometriosis but about five years ago I began to have intense hot flashes in the week off of the pill.  My doctor believed I was in menopause due to occasional FSH in the 20s-40s.  I switched to HRT, which was better.  Due to the side effects of the pills, however, and the worsening of my other health conditions, including pulmonary hypertension, I stopped the HRT in 2006.  I've had episodes of menopause since then, with FSH going as high as 150 at one point when I was on methotrexate.  This year, however, my periods have been regular, light, go for about three days and in about three week intervals.  My FSH is also swinging.  A few months ago I had intense endometriosis-type pain and a vaginal ultrasound was done.  I have some evidence of small endometriomas, and also some small fibroids and other cysts. My FSH was 5 on about Day 11 and two weeks later the day-3 FSH was 42.  My fertility specialist has decided not to run any further hormone tests and has told me that there was no chance I could become pregnant based on the FSH results and other past history.   He believes the other problems will resolve due to menopause.   I am still having monthly periods, occasionally very painful.  Does menopause often present this way?  Have you seen any patients who have a similar history?  I guess it is certain that pregnancy is not possible?  Thank you.

[Machelle Seibel, MD]

Although it is never possible to say who can and cannot conceive, you are correct in saying that it is unlikely to happen given your medical history. However, it is a good idea to talk with your internist and possibly a high risk OB doctor as a consult. The reason is that you could conceive with egg donation (getting an egg from another women) and fertilizing it by in vitro fertilization and putting it back into  your uterus to carry. Since the HT caused  you pulmonary hypertension, that could happen with pregnancy as well and it is wise to plan for it or decide it is too great a risk.

Your history of going "in and out" of menopause with periods coming and going and FSH getting higher and lower is not unusual in women with a similar history. Things typically get fairly consistent in the next year or so.
Machelle M. Seibel, MD